Showing papers in "European Journal of Ophthalmology in 2013"
TL;DR: Worldwide epidemiologic studies may help the clinician in the management of patients with inflammatory ocular diseases, enabling the comparison of different uveitis entities.
Abstract: PurposeWe describe the worldwide epidemiology of uveitis through a systematic literature review.MethodsData obtained from the most relevant studies published until November 2012 were reported.Resul...
227 citations
TL;DR: Patients treated for primary open-angle glaucoma or ocular hypertension often have ocular surface diseases, more often and more severely in older patients receiving more drugs and presenting with more severe glauca, which might have consequences on the burden of the disease and quality of life.
Abstract: Purpose. To determine the prevalence of ocular surface diseases and identify risk factors in a population of patients receiving antiglaucomatous eyedrops over the long term. Methods. An observational cross-sectional study was designed to investigate ocular surface signs and symptoms using simple clinical tools. An ocular surface disease intensity score was calculated based on 10 questions regarding ocular surface symptoms and signs with a 4-grade scale. Patients were classified into 3 groups (A, B, and C) according to this total score. A multinomial logistic regression was performed in order to identify risk factors for surface disease. Results. In an overall population of 516 patients, 49% belonged to group A, 30% to group B, and 21% to group C. The multivariate analysis showed that the following factors were correlated with the severity of ocular surface disease: patient age, number of daily eyedrops, past topical treatment changes for ocular intolerance (found in the history of 40% of the patients), intraocular pressure (found to be significantly higher in patients with more severe ocular surface disease), and glaucoma severity. Conclusions. Patients treated for primary open-angle glaucoma or ocular hypertension often have ocular surface diseases, more often and more severely in older patients receiving more drugs and presenting with more severe glaucoma. These high prevalence values might therefore have consequences on the burden of the disease in terms of adherence to treatment and quality of life.
93 citations
TL;DR: There is clinical evidence that the number of medications, their prolonged use, and the total BAK exposure are risk factors to develop ocular surface disease in patients with glaucoma.
Abstract: PurposeTo identify risk factors for developing ocular surface disease (OSD), to verify the prevalence of OSD, and to record efficacy of questionnaires in identifying symptoms' impact on patients' q...
82 citations
TL;DR: In this paper, the authors evaluated the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL).
Abstract: PurposeTo evaluate the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL).MethodsA multicenter, consecutive case series of patients...
60 citations
TL;DR: Work-related injuries were noted to have a much higher incidence of IOFBs and cataracts compared to non-work-related OGIs, and zone 3 injuries, rupture injuries, and a presenting VA of NLP were found to be significant predictors for a final VA ofNLP.
Abstract: Purpose.To describe the demographics and clinical characteristics of work-related open-globe injuries (OGIs) at a level I trauma center over a 10-year period.Methods.Retrospective series.Results.A ...
47 citations
TL;DR: Young patient age at the time of diagnosis of uveal melanoma is associated with lower rate of metastasis compared to mid-adults and older adults.
Abstract: Purpose.To determine the influence of patient age on life prognosis in patients with uveal melanoma.Design.Matched retrospective cohort study of 122 patients in each age category (young [≤20 years]...
45 citations
TL;DR: This review provides an up-to-date account of the literature regarding preservatives and the eye, as well as suggestions and recommendations on to when to use preservative-free antiglaucoma treatment.
Abstract: Purpose: To review and summarize the available literature on the effect of preservatives on the eye, to provide practical guidance for the clinical assessment of the ocular surface in glaucoma patients, and to define patient populations that might benefit from preservative-free topical intraocular pressure (IOP)-lowering agents. Methods: This manuscript is based on a combination of a literature review on preservatives and the eye and expert opinion from glaucoma specialists with an interest in ocular surface disease. Results: There is an increasingly recognized association between eyedrop preservatives and ocular surface disease. Preservative-free therapy is now available for a wide range of active compounds, although there are still some misconceptions regarding their appropriate use. For patients treated topically for glaucoma or ocular hypertension, a rough estimate could be that 20% may need treatment with topical IOP-reducing agents that are free from preservatives. Conclusions: This review provides an up-to-date account of the literature regarding preservatives and the eye, as well as suggestions and recommendations on to when to use preservative-free antiglaucoma treatment.
39 citations
TL;DR: Caregivers of patients with primary congenital glaucoma have significant emotional and psychological burden, and moderate to severe depression may be present in one-third of individuals giving primary care to children with congenital GlaucomA.
Abstract: PurposeTo assess the magnitude of caregiver burden and depression in primary caregivers of patients with primary congenital glaucoma.MethodsFifty-five primary caregivers of children diagnosed with ...
38 citations
TL;DR: At the time of cataract surgery distinct attention should be drawn to ophthalmologic biometric parameters, which are continuously changing even in adulthood, and to astigmatism above 1.0 D, present in >32% of the population.
Abstract: PurposeTo analyze the magnitude, orientation, and age-related changes of corneal astigmatism and its correlation with biometric parameters in healthy eyes.MethodsPatients over 15 years of age were ...
36 citations
TL;DR: Preliminary modeling work shows the potential of mathematical models to elucidate the mechanisms that contribute most significantly to glaucoma progression, and Mathematical modeling is a useful tool when used synergistically with clinical and laboratory data in the study of ocular blood flow and glAUcoma.
Abstract: Purpose.To discuss the role of mathematical modeling in studying ocular hemodynamics, with a focus on glaucoma.Methods.We reviewed recent literature on glaucoma, ocular blood flow, autoregulation, the optic nerve head, and the use of mathematical modeling in ocular circulation.Results.Many studies suggest that alterations in ocular hemodynamics play a significant role in the development, progression, and incidence of glaucoma. Although there is currently a limited number of studies involving mathematical modeling of ocular blood flow, regulation, and diseases (such as glaucoma), preliminary modeling work shows the potential of mathematical models to elucidate the mechanisms that contribute most significantly to glaucoma progression.Conclusion.Mathematical modeling is a useful tool when used synergistically with clinical and laboratory data in the study of ocular blood flow and glaucoma. The development of models to investigate the relationship between ocular hemodynamic alterations and glaucoma progressio...
36 citations
TL;DR: Blepharoptosis in children is most commonly dystrophic with poor levator function showing a predilection to left side affection and Associated strabismus, refractive errors, and amblyopia should be considered for proper management of these patients.
Abstract: PurposeTO study the demographic and clinical characteristics of children who present to our hospital with blepharoptosis.MethodsA retrospective review of the hospital records of children presenting...
TL;DR: Dry eye is common in early GO even in the absence of apparent exophthalmos and is associated with CAS and reduced corneal sensitivity, and the CAS correlated significantly with the Schirmer test.
Abstract: PurposeTo evaluate dry eye disease and corneal sensitivity in patients with early and active Graves’ ophthalmopathy (GO).MethodsA total of 52 eyes of 26 patients with early GO and 74 eyes of 37 age...
TL;DR: It is found that children with IDA had different peripapillary RNFL profile measured by Cirrus HD spectral-domain OCT, and ophthalmologists are cautioned when they measure RNFL thickness in children to diagnose glaucoma or other neuro-ophthalmic disorders.
Abstract: Purpose. To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness in children with iron deficiency anemia (IDA) in comparison with healthy controls and to investigate the correlation between peripapillary RNFL thicknesses and the hematologic parameters in these subjects. Methods. Forty eyes of 40 children with a diagnosis of IDA (anemic group) and 40 eyes of 40 age- and sex-matched healthy children (control group) were enrolled in this study. Peripapillary RNFL thickness measurements were performed using Cirrus HD optical coherence tomography (OCT). Results. Mean age of each group was 11.3±2.7 years. Average RNFL and RNFLs of superior and inferior quadrants were significantly thinner in the anemic group than in the control group (p=0.006, p=0.005, and p=0.005, respectively). In addition, average peripapillary RNFL thickness and RNFL thicknesses of superior, inferior, and temporal quadrants were correlated with hemoglobin levels (r1=0.734, p1<0.001, r2=0.456, p2=0.005, r3=0.598, p3<0.001, r4=0.349, p4=0.037, respectively) in anemic group. Conclusions. We found that children with IDA had different peripapillary RNFL profile measured by Cirrus HD spectral-domain OCT. We caution ophthalmologists when they measure RNFL thickness in children to diagnose glaucoma or other neuro-ophthalmic disorders.
TL;DR: Anti-inflammatory therapy is critical for the treatment of SS dry eye and clobetasone butyrate, at low dosage, proved to be safe and effective in treating this condition.
Abstract: PurposeTo study the effects of a low administration rate and low concentration (0.1%) of clobetasone butyrate eyedrops in patients with Sjogren syndrome (SS).MethodsThis prospective, double-masked,...
TL;DR: Regardless of radiation source, intravitreal injections of 2.0 ranibizumab induced significant reductions in macular edema and maintained or improved BCVA in most patients who were failing standard dose anti-VEGF therapy.
Abstract: PurposeTo evaluate the safety and tolerability and treatment efficacy of high-dose (2.0 mg) intravitreal ranibizumab for recalcitrant radiation retinopathy.MethodsA phase I to II open-label, nonran...
TL;DR: Combined vitreoretinal surgery and phacoemulsification is safe and effective in treating vitre theoretical abnormalities coexisting with cataract in diabetic and nondiabetic patients and diabetic patients should be monitored more carefully for fibrinous uveitis and posterior synechia in the early postoperative period.
Abstract: Purpose.To evaluate early and late postoperative anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with cataract and coexisting vitreoretina...
TL;DR: The results suggest that the sutureless technique using a bovine pericardial graft patch is a safe and rapid procedure for AGV implantation.
Abstract: PurposeTo evaluate the long-term outcomes of a surgical technique using a sutureless bovine pericardial patch graft for the implantation of an Ahmed glaucoma valve (AGV).MethodsThis was a pilot stu...
TL;DR: It would be advisable to prevent this intraocular pressure spike, especially when procedures are repeated, notably in patients with glaucoma, and use prophylactic pressure-lowering medications.
Abstract: PurposeThe aim of this study was to evaluate pressure increases after intravitreal injections (IVI) and the interest in using prophylactic pressure-lowering medications.MethodsThis was a prospective study of 250 anti–vascular endothelial growth factor IVI (ranibizumab) divided into 5 groups of 50 IVI (group 1: no intraocular pressure [IOP]–lowering medication; group 2: apraclonidine 1%; group 3: acetazolamide; group 4: fixed association brimonidine + timolol; group 5: fixed association dorzolamide + timolol). The IOP was measured before, immediately after (T1), 15 minutes after (T15), and 45 minutes after (T45) the IVI using a tonometer. The data were analyzed by analysis of variance followed by a Bonferroni as post hoc test if necessary.ResultsThe mean IOP peak in group 1 was 46.4±10 mmHg at T1, 21.7±10.2 mmHg at T15, and 15.4±8.6 mmHg at T45. It was not correlated with axial length (r=0.04, p=0.81) or lens status (phakic vs pseudophakic: p=0.88). A mild but significant correlation was found with age (r=...
TL;DR: Biofeedback rehabilitation with the MP-1 increases quality of vision in patients with STGD, leading to a stabilization of fixation and a consequent improvement of patients’ visual function and reading abilities.
Abstract: PurposeTo evaluate the efficacy of biofeedback (BF) microperimetric rehabilitation in patients with Stargardt disease (STGD).MethodsEighteen patients with STGD with unstable fixation located in the...
TL;DR: The GPA event analysis and expert subjective assessment showed high agreement between them and moderate agreement with GPA trend analysis, and both methods of GPA analysis offered high specificity, event analysis showed 83% sensitivity, and trend analysis had a 66% sensitivity.
Abstract: Purpose.To assess sensitivity, specificity, and agreement among automated event analysis, automated trend analysis, and expert evaluation to detect glaucoma progression.Methods.This was a prospecti...
TL;DR: In eyes with narrow pupil, the use of Malyugin Ring makes the surgery easier and allows for better functional results and smaller corneal endothelial cell loss in comparison with manual pupillary stretching with 2 hooks.
Abstract: PURPOSE To evaluate the results of phacoemulsification in eyes with a narrow pupil dilated with Malyugin Ring, in comparison with manual pupillary stretching with hooks. SETTING Department of Ophthalmology, Medical University of Lodz, Poland. MATERIALS AND METHODS The examined group (group 1) consisted of 23 eyes of 23 patients whose pupil was dilated using Malyugin Ring. The reference group (group 2) consisted of 17 eyes of 17 patients whose pupil was dilated manually by stretching with hooks. All patients underwent uneventful standard phacoemulsification. Patients were examined preoperatively, 1 day, and 1 month after the surgery. Best-corrected visual acuity (BCVA), intraocular pressure, anterior and posterior segment of the eye, and corneal endothelial cell density were evaluated. Statistical analysis was done using nonparametric tests. RESULTS Mean preoperative BCVA in group 1 was 0.31±0.27 and in group 2 it was 0.26±0.26 (p>0.05). In both groups there was a significant improvement in BCVA after the surgery (p<0.05). Mean postoperative BCVA in group 1 was 0.75±0.30 and in group 2 it was 0.56±0.56 (p<0.05). Mean corneal endothelial cell loss measured 30 days postoperatively amounted to 9.35±11% in group 1 and 13.77±8.0% in group 2 (p<0.05). No serious complications were found. CONCLUSIONS In eyes with narrow pupil, the use of Malyugin Ring makes the surgery easier and allows for better functional results and smaller corneal endothelial cell loss in comparison with manual pupillary stretching with 2 hooks.
TL;DR: Amniotic membrane transplantation may stop ulceration and promote corneal epithelialization in the majority of patients with the most severe chemical or thermal eye injuries in case of timely application of the operation and adequate fixation of the AMT graft.
Abstract: PURPOSE To analyze results of amniotic membrane transplantation (AMT) in treatment of corneal ulceration after severe chemical and thermal injuries. METHODS Analysis of 55 AMT in 53 patients (53 eyes) with corneal ulceration and limbal deficiency 180-360° of the limbus after grade 4-6 (Dua classification, 2001) chemical and thermal injuries was performed. Mean terms of the operation were 46.1 ± 46.4 days after the injury (range 8-181 days). Preoperative visual acuity (VA) was <0.01 in 33/53 patients (62.3%). Mean follow-up period was 8.8 ± 10.1 months (range 1.5-46 months). RESULTS Further corneal ulceration was prevented in 54/55 cases (98.1%), cornea epithelialized after 42/55 AMT (76.3%). Mean terms of corneal epithelialization were 24.2 ± 26.7 days after AMT (range 6-123 days). Corneal defect recurred in 3/42 successful cases (7.1%). Limbal deficiency of different extent with subsequent corneal conjunctivalization developed in all successful patients. The VA was ≥0.01 (range 0.01-1.0) in 23/42 patients (54.8%) with corneal epithelialization. The VA at the last visit was improved on 2 and more lines on the eye chart compared to preoperative VA in 15/42 patients with corneal epithelialization (35.7%), did not change in 18/42 successful patients (42.9%), and decreased on one line in 9/42 of these patients (26.2%). Symblepharon developed in 23/42 successful patients (54.7%). CONCLUSIONS Amniotic membrane transplantation may stop ulceration and promote corneal epithelialization in the majority of patients with the most severe chemical or thermal eye injuries in case of timely application of the operation and adequate fixation of the AMT graft.
TL;DR: Naso-orbito-ethmoidal fracture is the main cause of traumatic NLDO, commonly in young male individuals, and computed tomography–dacryocystography is a useful imaging modality in preoperative assessment and surgical planning.
Abstract: PurposeTo review clinical profile, management, and outcome in cases of traumatic nasolacrimal duct obstruction (NLDO).MethodsA retrospective analysis of 28 patients with the diagnosis of traumatic NLDO during a 12-year period was done. Data regarding nature and pattern of injury, associated damage, clinical features, investigations, management, outcome, and follow-up were reviewed.ResultsOf the 28 patients reviewed in the study, 19 (68%) were male and 9 (32%) were female. Mean age of the patients was 30.1 years. The most common cause of traumatic NLDO was high-velocity blunt injury encountered in road traffic accidents (70%), and the most common pattern of injury was naso-orbito-ethmoidal fractures (64%). Traumatic telecanthus was the most commonly associated periocular injury (54%). Twenty-one patients (75%) were investigated with computed tomography–dacryocystography. A total of 26 patients were treated with external dacryocystorhinostomy with (75%) or without (18%) silicon intubation and 2 (7%) patient...
TL;DR: Large-area treatment seems to be a more efficient application method of MMC during trabeculectomy, as patients treated with a larger size of surface area had a higher IOP reduction within the first postoperative year.
Abstract: PurposeTo compare 2 different application methods of mitomycin C (MMC) in patients undergoing trabeculectomy.MethodsThis retrospective trial compared outcomes of 191 eyes that underwent trabeculect...
TL;DR: Snellen et al. as discussed by the authors presented the short-term favorable clinical results with the dexamethasone intravitreal implant in a patient with florid idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome (IRVAN).
Abstract: Purpose To present the short-term favorable clinical results with the dexamethasone intravitreal implant in a patient with florid idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome (IRVAN). Methods A 26-year-old man presented with significant bilateral deterioration of vision due to vitreous hemorrhage and neuroretinitis with a background of vasculitis and neovascularization. The patient was initially treated with high doses of oral steroids (80 mg prednisolone), which were gradually tapered, and also received extensive argon laser photocoagulation in ischemic areas in both eyes. Despite vigorous treatment and an initial positive response to treatment, pars plana vitrectomy was eventually needed to address the recurrent vitreous hemorrhages in the left eye. Consequently, visual acuity improved from 0.1 to 0.2 (Snellen) and there was no relapse of vitreous hemorrhage. Persistent macular edema was noted, however, and it was decided to treat with a dexamethasone 0.7 mg intravitreal implant. Results Following the dexamethasone implant OS, visual acuity improved significantly from 0.2 to 0.5 (Snellen), the patient reported much less distortion, and there was marked reduction in central retinal thickness from 467 to 234 microns. The patient remains in remission without any exudation in the macula at 4 months follow-up. Conclusion Dexamethasone 0.7 mg intravitreal implant appears to be a safe and effective solution in the treatment of macular edema in patients with IRVAN syndrome and could possibly be a treatment option for other cases of inflammatory induced macular edema.
TL;DR: The results suggest that corneal collagen CXL can be a successful treatment at certain stages of keratoconus, offering a way to stop progression in keratometric indices.
Abstract: Objective: Riboflavin UVA (collagen crosslinking [CXL]) treatment for keratoconus is a method for stabilizing or improving corneal properties. Our aim was to evaluate changes in corneal topography indices after CXL. Methods: A total of 38 eyes of 25 patients (mean age 29.36 ± 9.7 years) were treated with CXL technique. The follow-up period was 36 months. Slit-lamp examination, visual acuity tests, and pachymetry measurements were performed; in order to obtain the following numerical data, corneal topography (TMS-4; Tomey) was used: simulated keratometry (K1, K2), CYL (cylinder value), SAI (surface asymmetry index), IAI (irregular astigmatism index), SRI (surface regulatory index), ACP (average corneal power), and CEI (corneal eccentricity index). Treatments were performed with In-Pro CCLLix (Germany) equipment. Results: The values of mean K1 (p = 0.82), cylinder (p = 0.73), SAI (p = 0.99), IAI (p = 0.82), SRI (p = 0.73), ACP (p = 0.73), K2 (p = 0.8), and CEI (p = 0.99) showed no significant changes at the end of the examination period. Uncorrected visual acuity remained unchanged (p = 0.32). However, best-corrected visual acuity changed from 0.21 ± 0.17 to 0.12 ± 0.11 in logMAR scale, but this deviation was not considered significant (p = 0.08). No change was observed in intraocular pressure (p = 0.79). Cornea remained clear and during follow-up period no corneal thinning was observed (p = 0.78). Conclusion: Our results suggest that corneal collagen CXL can be a successful treatment at certain stages of keratoconus, offering a way to stop progression in keratometric indices.
TL;DR: Rise in IOP during the management of complications following DALK related to DM was found to be important in the development of FDP, an uncommon but well-known complication of keratoplasty.
Abstract: PURPOSE To report 8 cases of fixed dilated pupilla (FDP) (Urrets-Zavalia syndrome) following deep anterior lamellar keratoplasty (DALK) with Descemet membrane (DM) perforation and change of management to avoid FDP. METHODS Retrospective analysis of 106 eyes of 94 patients who underwent DALK for various diagnoses was performed. Intraoperative and postoperative details of eyes that developed DM detachment, FDP, as well as change of management to prevent rise of intraocular pressure (IOP) (as a common trait of these eyes) were evaluated. RESULTS Descemet membrane perforation developed in 17 (16%) eyes. Fixed dilated pupilla was diagnosed in 8 (7.5%) eyes. Seven of the eyes with FDP experienced DM perforation and air bubble was left in anterior chamber (AC) to tamponade DM perforation at the end of the surgeries. Five eyes developed FDP in the early postoperative period and the remaining 2 eyes, which were diagnosed as double AC and managed by repeated air injections, developed FDP in the third postoperative week. The last patient who experienced intense postoperative inflammation had a fixed dilated pupil in the third postoperative week. CONCLUSIONS Fixed dilated pupilla is an uncommon but well-known complication of keratoplasty. The exact mechanism remains unknown but postoperative high IOP seems to be an important risk factor following complicated DALK. Rise in IOP during the management of complications following DALK related to DM was found to be important in the development of FDP in this series.
TL;DR: Oral propranolol should be considered in the armamentarium for selected DCH after the retinal detachment of a 17-year-old boy slowly resolved over 1 month and the retina remained attached at 10 months follow-up.
Abstract: PurposeDiffuse choroidal hemangioma (DCH), a feature of Sturge-Weber syndrome, is most often treated with whole-eye radiotherapy at stage of complications such as retinal detachment.MethodsThis is ...
TL;DR: Toric implantable Collamer lens was safe and effective in correcting postkeratoplasty myopia and astigmatism in keratoconus patients and no complications were observed postoperatively.
Abstract: PurposeTO evaluate the efficacy and safety of a toric implantable Collamer lens (Visian TICL®) for correction of high postkeratoplasty ametropia in patients with keratoconus.MethodsSeven eyes of 7 ...
TL;DR: The ranibizumab-only group and the switching from bevacIZumab to ranibzumab group seemed superior to the ranIBizumAB to bevACizumabs group.
Abstract: PURPOSE To report the results of switching from intravitreal bevacizumab to ranibizumab or vice versa in the treatment of choroidal neovascularization (CNV) due to age-related macular degeneration. METHODS Twenty eyes of 18 patients that underwent switch from intravitreal bevacizumab to ranibizumab and 10 eyes of 8 patients that underwent switch from ranibizumab to bevacizumab were retrospectively analyzed. The results were compared with 41 eyes of 37 patients treated with ranibizumab only. All eyes initially received 3 injections of ranibizumab or bevacizumab, which were repeated as needed (PRN dosing). Anti-vascular endothelial growth factor therapies were switched because of general health insurance applications and cost problems. The main outcome measures were best-corrected visual acuity (BCVA), injection number, and central macular thickness (CMT) obtained by optical coherence tomography. RESULTS Once all patients evaluated together at the final visit, the mean BCVA improved and CMT decreased. When switching groups were taken into consideration, switching yielded improved BCVA and reduced CMT following switching. After switching, BCVA continuously improved in the bevacizumab to ranibizumab group, but stayed stable in the ranibizumab to bevacizumab group. The CMT was reduced at the switching time in both groups, but did not change after the switch. Final visual acuity improved or stabilized in all eyes in the ranibizumab-only group. The BCVA worsened in 20% of eyes in the bevacizumab to ranibizumab group and in 40% of eyes in the ranibizumab to bevacizumab group. CONCLUSION The ranibizumab-only group and the switching from bevacizumab to ranibizumab group seemed superior to the ranibizumab to bevacizumab group.